Provider Demographics
NPI:1306082995
Name:NAKABAYASHI, SOPHIA S (MA)
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:S
Last Name:NAKABAYASHI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 GRAND VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5214
Mailing Address - Country:US
Mailing Address - Phone:310-751-1145
Mailing Address - Fax:
Practice Address - Street 1:4160 GRAND VIEW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5214
Practice Address - Country:US
Practice Address - Phone:310-751-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health